Duke AIDS Legal Project receives grant for policy project

March 7, 2011Duke Law News

Duke Law School has received a Southern REACH grant from AIDS United to launch a new policy initiative through which students and faculty will conduct research, develop policy recommendations, and develop educational resources aimed at ensuring privacy and access to healthcare for North Carolinians living with HIV/AIDS.

The $58,500 grant -- to be augmented with funding from Duke Law School -- will allow faculty and students in the Duke AIDS Legal Project to examine some of the systemic problems that prevent clients from getting the care they need and the rights they deserve, says Clinical Professor Carolyn McAllaster, director of the Duke AIDS Legal Project.

The new AIDS Legal Project Policy Initiative will focus on four long-term goals: reducing stigma faced by people living with HIV/AIDS in North Carolina as a result of confidentiality breaches; addressing transportation problems for those who need care; ensuring adequate funding for the N.C. AIDS Drug Assistance Program so that lower-income patients can receive the medications they need; and ensuring that the medical and supportive service needs of people living with HIV/AIDS are taken into account as the state and other agencies plan for implementation of healthcare reform.

To address these issues, students and faculty will conduct legal and policy research, develop educational materials for healthcare providers, legislators, and advocacy organizations, and draft policy recommendations. They also will develop educational materials for people living with HIV/AIDS to help them better understand their right to privacy and the options available to them for healthcare and medication. Key to that effort is developing a deep understanding of how healthcare reform will impact people with HIV/AIDS.

“We want to better understand the current legal and policy landscape in our target areas,” McAllaster says. “Through work with individual clients, we have considerable experience with the problems they face. Now we need to find the trigger points where change is possible.”

Through Duke Law’s clinical program, law students provide legal services to underserved members of the community, under the supervision of law faculty and practitioners. The AIDS Legal Project is Duke’s oldest legal clinic and the only law office in North Carolina devoted exclusively to the full spectrum of issues faced by people with HIV. Students in the clinic typically assist clients with legal issues concerning Social Security and private disability, child custody and end-of-life planning, insurance, privacy, and discrimination.

Through these efforts, students frequently encounter laws and policies that hinder their ability to help clients, says McAllaster. “For example, many of our clients in rural parts of the state have difficulty getting to their medical appointments. Many don’t want to go to local clinics, where their status could be disclosed to neighbors. They want to come here to Duke, or go to nearby counties.

“Medicaid funds transportation to medical appointments, but Medicaid transportation often cannot cross county lines -- even by a mile,” says McAllaster. The policy, innocuous on its face, leaves low-income people living with HIV/AIDS with a difficult choice -- get the care they need at the risk of disclosing their status, or forgo the care.

At the heart of many of these problems is the stigma associated with HIV/AIDS, McAllaster says. “Stigma is wrapped up in everything we are looking at -- the transportation issues, the access to care. A big part of what we want to do is educate people about their rights and responsibilities,” she says.

She notes that the AIDS Legal Project frequently fields calls from clients whose confidentiality was breached by nurses or doctors in emergency rooms, or staff in a courtroom. “We want to help educate providers, to get them to stop and think -- don’t go into a waiting room and talk to a patient about their HIV medications,” she says.

The AIDS Legal Project Policy Initiative launches this spring; a new clinical course focusing on policy will be offered to students in the fall 2011 semester.

“Over the years we’ve become very knowledgeable about policies and laws that adversely affect our clients,” says McAllaster, who oversees student work in the clinic with Supervising Attorney Allison Rice. “Through direct legal representation, we can provide help for individual clients. But there are policies and other issues that continue to interfere with obtaining just results. We haven’t had time to step back and work on those issues. We’re very excited to have the time and the resources to do that now.”